The present invention relates to surgical instruments and pertains particularly to an apparatus and method for passing sutures through tissue.
Many surgical techniques are currently carried out in very confined space both by choice and by necessity. Open surgery is seldom used where other techniques such as arthroscopic, endoscopic or laproscopic surgical techniques are available because of the benefits to the patient.
Such techniques reduce the pain and discomfort to the patient and decreases the recovery time and scarring. However, the suturing of tissue under such conditions is difficult with the tools and instruments available today.
While many instruments have been proposed for this problem in the past, such instruments have a number of drawbacks. Presently available instruments or suture passers generally fall in two main categories. One type of device is designed to propel a relatively rigid, usually monofilament, suture with mechanical force through a cannula or hollow needle through the tissue. These devices cannot pass a braided suture through the tissue. Another type of device uses a solid needle or wire with a closed or open eyelet to carry the suture through tissue. The open eyelet may catch on tissue making passage through the tissue difficult. These devices also require other instruments to grasp and pull the free suture from the needle or wire.
A number of the prior art instruments are disclosed in the following patents:
U.S. Pat. No. 4,890,615 to Caspari et al, No. 919,138 to Drake et al, No. 3,840,017 to Violante, No. 4,224,947 to Fukuda, and U.S. Pat. No. 4,643,178 to Nastari et al disclose suturing instruments wherein sutures are passed through hollow needles after the needles penetrate through tissue to be sutured, and having the disadvantage of requiring grasping of the suture material by an instrument not useful in arthroscopic surgery.
U.S. Pat. No. 4,493,323 to Albright et al, and Nos. 4,602,635 and 4,621,640 to Mulhollan et al disclose instruments for internal suturing in confined space, but require multiple instrument manipulation and movement of needles carrying sutures entirely through tissue to be sutured. The Albright et al patent discloses a pair of needles that are forced outwardly through the end of a tube by a plunger to penetrate and extend through the tissue to be sutured to be grasped and pulled by the surgeon to position a suture thread loop attached to the needles. The Mulhollan et al patent U.S. Pat. No. 4,621,640 discloses a curved needle carried by a pivoting head movable to set the needle in the tissue to be sutured. The needle is then released and the instrument withdrawn and another instrument inserted to pull the needle through. Mulhollan et al patent U.S. Pat. No. 4,602,635 discloses an instrument for tying knots in sutures in a manipulation area external of the body after the sutures are passed through the tissue. The knots are then forced into place adjacent the tissue by another instrument.
U.S. Pat. No. 1,815,725 to Pilling et al, No. 3,470,875 to Johnson, No. 3,842,840 to Schweizer, No. 3,946,740 to Bassett and No. 4,164,225 to Johnson et al disclose suturing instruments having pivoted, scissor-like arms with a needle at the end of an arm forced through tissue to be sutured and into the end of another arm where the suture is grasped or clamped. The instruments are of a structural design that is not practical in arthroscopic surgery.
U.S. Pat. No. 4,312,337 to Donohue discloses an instrument for drilling and wiring bones having scissor-like arms carrying cannula sections through which a wire is passed, the wire being cut and tied after the cannula sections are withdrawn. The structure is such that it does not permit the instrument to be used in arthroscopic surgery.
Accordingly there is a need for improved suturing instruments for effective use in close confined spaces.